Navigate4Me Service Navigator US Telecommute (Nationwide)

UnitedHealth Group

25063 Dilworth Rd

Harlingen, TX 78552

Full-Time

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Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.

Turn on the news on any night of the week and you're likely to hear about the changes that are sweeping through our health care system. It's dramatic. It's positive. And it's being led by companies like UnitedHealth Group. Now, you can take advantage of some of the best training and tools in the world to help serve our existing and new customers.

This role is responsible for coordination of member navigation plans with Optum clinical and non - clinical staff supporting members in the Navigate4Me program including members referred for CHF, DHN, PSU, HPC, Advanced Illness, ESRD and Transplant. This role will work one - on - one with assigned Optum clinical and non - clinical staff and will support members and their caregivers associated with that assignment in a case management capacity. Members will be warm transferred from Optum clinical and non - clinical staff. Daily responsibilities include warm transfers of members from assigned Optum clinical and non - clinical staff, inbound / outbound calls from / to assigned members and member account research and issue resolution.

Primary Responsibilities:

Conduct proactive research on assigned member accounts to identify service issues and inform member plan of navigation in coordination with assigned Optum clinical and / or non - clinical staff outreach. Research includes, but is not limited to:

Recent contacts

Alerts

PCP on account

LIS

Medicaid

Appeals

Billing

Claims Denials

PAs

Mail Order

Transportation

Communicate with assigned Optum clinical and / or non-clinical staff regarding member service issues that are proactively identified, member identified and close the loop on the resolution of service issues to inform the plan of navigation for assigned members.

Resolve member service inquiries related to:

Medical benefits, eligibility and claims

Terminology and plan design

Financial spending accounts

Pharmacy benefits, eligibility and claims

Correspondence requests

Educate members about the fundamentals of health care benefits including:

Managing health and well being

Maximizing the value of their health plan benefits

Selecting the best health plan to meet their health needs

Choosing a quality care provider and appointment scheduling

Premium provider education and steerage

Pre - authorization and pre - determination requests and status

Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow - up with the member

Communicate with members and their care givers regarding anticipated member service needs and resolution of issues

Research complex issues across multiple databases and work with support resources to own the resolution of all customer issues and anticipate their future healthcare needs or potential opportunities to improve the experience

Interact with executives and senior leaders to identify and / or resolve member issues including ongoing communication of issue outcome

Build and maintain an elaborate list of business partners across all lines of business to escalate member inquiries on an as needed basis

Employees may be asked to work independently after hours to resolve urgent issues that surface after normal business hours. This role has the ability to work outside of established procedures to ensure high level member satisfaction

Identify gaps in processes and work closely with other departments for process improvement

The Boomer generation is the fastest growing market segment in healthcare. And we are the largest business in the nation dedicated to serving their unique health and well - being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our Healthcare system. Ready? It's time to do your life s best work.